Basic Information
| Provider Information | |||||||||
| NPI: | 1437157369 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWBURYPORT GASTROENTEROLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 1/2 FORRESTER ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019501938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784654622 | ||||||||
| FaxNumber: | 9784654111 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 1/2 FORRESTER ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019501938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784654622 | ||||||||
| FaxNumber: | 9784654111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOVER | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9784654622 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.